Childhood otitis media with effusion

Otitis media with effusion (OME or ‘glue ear’) is the most common cause of hearing impairment in childhood. The condition is generally self-limiting, but may occur during a period when poor hearing may temporarily impede speech and language development and social behaviour. About 80% of children aged 10 will have been affected by an episode of otitis media with effusion during childhood mostly in the first 3 years. With no treatment, the natural history of OME is generally of spontaneous resolution. Watchful waiting with monitoring of hearing over a 6-month period will result in spontaneous resolution of the OME in over 90% of children. • Has he had frequent ear infections? OME may occur and persist in the absence of infection. However, >50% of episodes of OME follow episodes of acute otitis media (AOM). AOM as a precursor of OME is more common in younger children, under the age of 3 years. Children with OME typically experience up to five times more episodes of AOM than those without OME. OME and episodes of AOM are more common is those attending daycare. • What difficulties does he have with hearing and for how long have these been apparent? Moderate hearing loss secondary to OME may present more difficulty in a group situation, such as nursery. Parents frequently report lack of awareness of their child’s mild to moderate hearing loss. • Is the child’s speech and language development age appropriate? • Were the pregnancy, delivery and neonatal period normal? Consider uncommon causes of sensorineural hearing loss, both hereditary and acquired. • Previous medical history. Special risk factors such as Down syndrome, cleft palate or learning difficulties may modify the approach to management. • Family history of hearing loss. A child with OME will occasionally have an underlying sensorineural hearing loss. • Social history. Parental smoking should be discussed and discouraged as a contributory factor in childhood chronic middle ear disease.